Comparing Medicare plans in Maryland
Medicare is the federal health insurance program for adults age 65 and older, as well as younger individuals with specific qualifying disabilities. However, turning 65 does not mean your healthcare is entirely free or automatically sorted out for you. Medicare is a complex system of interconnected parts, private plans, and strict enrollment windows.
If you are approaching Medicare eligibility in Maryland, the sheer volume of mail, television commercials, and conflicting advice can be overwhelming. The purpose of this guide is to strip away the marketing noise and explain exactly how Medicare functions. By understanding the core mechanics of the system—how the four “Parts” work, what they cost, and the two major paths you must choose between—you will have the foundation required to evaluate which coverage option makes the most financial and medical sense for your retirement.
Before breaking down the parts of Medicare, it is essential to understand the financial terms used to describe how you share costs with your insurance plan. If you are transitioning from an employer-sponsored health plan, you have likely encountered these concepts, but Medicare handles them in specific ways:
Medicare is a federal program, meaning the baseline eligibility rules in Maryland are identical to the rest of the country. You qualify for Medicare if you are a U.S. citizen or permanent legal resident who has lived in the United States for at least five consecutive years, and you meet one of the following criteria:
The Medicare system is divided into four distinct components, usually referred to as “Parts.” The most important concept to grasp is that Parts A and B together make up Original Medicare, which is administered directly by the federal government. Parts C and D are sold by private insurance companies that are approved and regulated by Medicare.
Part A is designed to cover your inpatient medical needs. If you are admitted to a facility, Part A is what pays the bulk of the room, board, and nursing care.
What Part A Covers:
What Part A Costs: For most Marylanders, Part A is “premium-free.” If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters) over your lifetime, you do not pay a monthly premium for Part A.
However, Part A is not entirely free to use. It comes with a deductible that applies per “benefit period,” not per calendar year. If you are admitted to the hospital, you must pay the Part A deductible before Medicare covers your stay. If you leave the hospital and stay out for 60 consecutive days, your benefit period resets, meaning you could owe that deductible multiple times in a single year if you have multiple isolated hospitalizations.
If Part A is for when you are lying in a hospital bed, Part B is for nearly everything else. This is the coverage you use for day-to-day healthcare.
What Part B Covers:
What Part B Costs: Unlike Part A, everyone pays a monthly premium for Part B. The standard base premium fluctuates slightly year to year based on federal funding, but typically hovers in the range of $174 to $185 per month.
If you have a higher income, you will pay more than the standard premium. This is known as the Income-Related Monthly Adjustment Amount (IRMAA). The federal government looks at your tax return from two years prior to determine your IRMAA tier. If your modified adjusted gross income (MAGI) crosses specific thresholds, a surcharge is added directly to your Part B and Part D premiums.
When you use Part B services, you first pay a small annual deductible. Once that deductible is met, Part B covers 80% of the Medicare-approved amount for your services. You are responsible for the remaining 20% coinsurance.
It is entirely legal to rely solely on Original Medicare (Parts A and B) for your healthcare. However, doing so is highly financially risky.
The core structural weakness of Original Medicare is the Part B coinsurance. Because Medicare pays 80% of your outpatient bills and you pay 20%, you are exposed to significant liability if you require expensive treatments. Furthermore, Original Medicare has no out-of-pocket maximum.
If you need a $100,000 outpatient procedure, your 20% coinsurance leaves you with a $20,000 bill. If you need ongoing, expensive chemotherapy infusions administered in a clinical setting (which falls under Part B), you will pay 20% of those costs infinitely, with no cap to protect you.
Additionally, Original Medicare does not cover most prescription drugs you pick up at a pharmacy, nor does it cover routine dental care, vision exams, or hearing aids.
Because of this exposure, almost no one stays on just Original Medicare. Instead, you face a decision at age 65. You must choose between two distinct paths to protect your finances and round out your coverage.
When you enroll in Medicare, you will choose one of two primary ways to receive your benefits:
| Feature | Path 1: Medigap + Part D | Path 2: Medicare Advantage (Part C) |
|---|---|---|
| Core Structure | You stay on federal Original Medicare and buy secondary private policies to fill the gaps. | A private insurance company takes over your Medicare benefits and bundles them into one plan. |
| Provider Network | No networks. You can see any doctor or hospital in the U.S. that accepts Medicare. | Strict networks (HMO or PPO). You generally must use local doctors and hospitals contracted with the plan. |
| Monthly Costs | Higher fixed monthly costs (you pay premiums for Part B, Medigap, and Part D). | Lower monthly costs (many plans offer $0 premiums beyond your standard Part B premium). |
| Out-of-Pocket Costs | Extremely low and predictable. Medigap covers the 20% coinsurance and most deductibles. | Pay-as-you-go through copays. Plans have a hard Out-of-Pocket Maximum to protect you. |
| Referrals | No referrals required to see a specialist. | Referrals often required in HMO plans; PPOs offer more flexibility at a higher cost. |
| Extra Benefits | None. Does not cover routine dental, vision, or hearing. | Frequently includes built-in dental, vision, hearing, and fitness (SilverSneakers) benefits. |
Both paths are legitimate, but they serve completely different healthcare philosophies and financial strategies. Let’s explore exactly how each component works in Maryland.
A Medicare Supplement plan, universally called Medigap, is private insurance designed to sit behind Original Medicare and pay the bills that Medicare leaves behind.
If you choose this path, Original Medicare remains your primary insurance. When you go to the doctor, you hand them your red, white, and blue Medicare card, and they bill the federal government. Medicare pays its 80% share, and then electronically forwards the remainder of the bill to your Medigap company, which pays the final 20%.
Medigap policies are standardized by the federal government and identified by letters (Plan A through Plan N). This standardization is a massive advantage for consumers: a Plan G sold by Carrier X provides the exact same medical coverage as a Plan G sold by Carrier Y. The only difference is the price and the company’s reputation for customer service.
The two most popular Medigap plans for new enrollees in Maryland are Plan G and Plan N:
The single most important rule regarding Medigap is your Open Enrollment Period.
When you are 65 or older and you enroll in Medicare Part B, a 6-month clock begins ticking. During these six months, you have a guaranteed issue right to buy any Medigap policy sold in Maryland, regardless of your health history. The insurance company cannot deny you coverage, and they cannot charge you more because of pre-existing conditions.
Once this 6-month window closes, you lose this federal protection. If you try to buy a Medigap policy later, or if you want to switch from Medicare Advantage back to a Medigap plan, the insurance company will put you through medical underwriting. They will review your medical records, ask about your health history, and they have the legal right to deny you a policy entirely or charge you exorbitant premiums if you are not perfectly healthy.
If you want the freedom to see any doctor without networks, you must prioritize buying a Medigap policy during this initial window.
Medicare Advantage, also known as Part C, is the alternative to Original Medicare. If you choose this path, you are electing to receive your Medicare Part A, Part B, and usually your Part D drug coverage through a single private insurance company (such as UnitedHealthcare, CareFirst BlueCross BlueShield, Wellpoint, or Kaiser Permanente).
The federal government pays these private companies a set amount every month to manage your care. In exchange, the private company takes on the financial risk of your healthcare.
When you enroll in a Medicare Advantage plan, you are still technically in the Medicare system (you still must pay your Part B premium), but Original Medicare is no longer primary. You must use the private plan’s network and follow its rules.
Medicare Advantage plans operate similarly to the insurance you likely had while working:
The primary reason Medicare Advantage is wildly popular is the combination of low premiums and extra perks. Many Advantage plans in Maryland charge a $0 monthly premium (beyond your mandatory Part B premium).
Furthermore, these plans bundle in benefits that Original Medicare expressly forbids paying for:
The trade-off for these low costs and extra perks is control. You trade the absolute freedom to see any doctor nationwide (Medigap) for restrictive local networks and managed care rules, where the insurance company may require prior authorization before approving a surgery or an expensive MRI.
Original Medicare does not cover the prescription drugs you pick up at your local pharmacy. To get coverage, you must enroll in Medicare Part D.
If you choose Medicare Advantage, Part D is almost always built directly into the plan. If you choose the Medigap path, you must purchase a standalone Part D plan from a private insurance company.
Part D plans organize medications into “tiers” on a list called a formulary.
When choosing a drug plan, the premium is only one piece of the puzzle. The most important factor is whether your specific medications are on the plan’s formulary, what tier they are on, and what the copays are. A plan with a $0 premium could cost you thousands more over a year if it does not cover your specific brand-name medication.
The Inflation Reduction Act fundamentally changed Medicare Part D to protect seniors from catastrophic drug costs. Starting in 2025 and continuing forward, out-of-pocket spending on covered Part D prescription drugs is capped at $2,000 per calendar year.
Once your deductibles, copays, and coinsurance for covered medications hit $2,000, you will pay $0 for your covered drugs for the remainder of the year. This is a monumental shift for individuals taking expensive tier 4 or 5 specialty medications for conditions like cancer, rheumatoid arthritis, or multiple sclerosis.
Note: This cap applies only to drugs covered by your plan’s formulary. If you take a medication that is not on your formulary and you do not secure an exception, those costs do not count toward your $2,000 cap.
Part D is technically optional, but if you do not have creditable drug coverage (like from an employer) and you delay enrolling when you are first eligible, you will face a permanent late enrollment penalty. The penalty is 1% of the national base beneficiary premium for every full month you went without coverage. This penalty is added to your monthly premium for the rest of your life.
Medicare is uncompromising regarding its deadlines. Missing an enrollment window can result in lifelong financial penalties or months without health coverage.
Your IEP is a 7-month window wrapped around your 65th birthday. It includes:
This is when most people enroll in Part A, Part B, and their drug or Advantage plans. If you enroll during the first three months, your coverage begins on the first day of your birthday month.
If you are still working at age 65 and have health coverage through an employer with 20 or more employees, you can safely delay Part B and Part D without penalty.
When you eventually retire or lose that employer coverage, you trigger a Special Enrollment Period. You have an 8-month window to enroll in Part B without penalty. However, you only have a 2-month window to enroll in Part D or a Medicare Advantage plan. (It is highly recommended to line up your Medicare coverage before your employer coverage actually ends to ensure a seamless transition).
Running from October 15 to December 7 every year, AEP is the window where anyone can make changes to their coverage for the upcoming calendar year. During AEP, you can:
Note: AEP is not an open window to buy a Medigap plan without underwriting. Medigap relies on your one-time 6-month Open Enrollment Period.
Running from January 1 to March 31, this window is exclusively for people who are already enrolled in a Medicare Advantage plan. If you find you dislike your plan’s network or benefits, you have one opportunity during this window to switch to a different Advantage plan or drop it entirely to return to Original Medicare (and pick up a standalone Part D plan).
If you have a limited income, there are federal and state programs available to help shoulder the costs of Medicare.
Medicare Savings Programs (MSPs): Managed by the state of Maryland, MSPs help pay for your Medicare premiums and, in some cases, your deductibles and coinsurance. There are different levels (QMB, SLMB, and QI) based on strict income and asset thresholds. If you qualify for the Qualified Medicare Beneficiary (QMB) program, the state pays your Part B premium and acts as a secondary payer for your medical bills, effectively wiping out your copays and coinsurance.
Extra Help (Low-Income Subsidy): This federal program helps individuals pay for their Part D premiums, deductibles, and drug copays. The Inflation Reduction Act expanded Extra Help, allowing anyone making up to 150% of the federal poverty level to qualify for full benefits, dramatically lowering pharmacy costs.
Maryland Senior Prescription Drug Assistance Program (SPDAP): Unique to Maryland, SPDAP provides a monthly subsidy to help moderate-income residents pay their Medicare Part D or Medicare Advantage prescription drug premiums. To qualify, you must be a Maryland resident enrolled in Medicare, not be eligible for full Medicaid, and have an income below 300% of the federal poverty level. This program is a vital lifeline for Marylanders who make just slightly too much money to qualify for federal Extra Help.
Review these general requirements to see if you should apply for Part D financial assistance.
Reading about the parts of Medicare is one thing; deciding which path is best for your specific life requires a framework. When deciding between Medigap and Medicare Advantage, use this logic map based on your personal priorities.
Choose Path 1 (Original Medicare + Medigap + Part D) If:
Choose Path 2 (Medicare Advantage) If:
Medicare is not a one-size-fits-all program. The best coverage for your neighbor might be entirely wrong for your medical needs and budget. Your first step is to confirm your Initial Enrollment Period dates. If you are retiring soon, verify exactly when your employer coverage ends to avoid overlapping premiums or triggering a gap in coverage.
Next, compile a complete list of your current medical providers and, most importantly, a list of every prescription medication you take, including the exact dosages. This list is the key to comparing Part D and Medicare Advantage plans accurately.
Once your list is compiled, do not guess at the math. Work through your specific scenarios with a licensed professional who can run your medications through the plan finders and verify which plans your Maryland doctors actually accept.
Compare local Advantage, Medigap, and Part D options tailored to your specific doctors and prescriptions.
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